Surgical treatment of the osteoporotic spine with bone cement-injectable cannulated pedicle screw fixation: technical description and preliminary application in 43 patients

Abstract

OBJECTIVES:To describe a new approach for the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws.METHODS:Between June 2010 and February 2013, 43 patients with degenerative spinal disease and osteoporosis (T-score <-2.5) underwent lumbar fusion using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. Patients were given radiographic follow-up examinations after 3, 6, and 12 months and once per year thereafter.RESULTS:All patients were followed for a mean of 15.7±5.6 months (range, 6 to 35 months). The Visual Analog Scale and Oswestry Disability Index scores showed a significant reduction in back pain (p = 0.018) and an improvement in lower extremity function (p = 0.025) in patients who underwent lumbar fusion using the novel screw. Intraoperative cement leakage occurred in four patients, but no neurological complications were observed. Radiological observation indicated no loosening or pulling out of the novel screw, and bone fusion was excellent.CONCLUSIONS:The described polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws can reduce pain and improve spinal dysfunction in osteoporotic patients undergoing osteoporotic spine surgery.

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

“…Clinically, cannulated screw fixation is considered more efficient than other screw-fixation methods, including cement-augmented solid-screw fixation. 21 The comparison between cannulated and solid screws in the present study also revealed that CPNaugmented cannulated screws had better antipullout ability than CPN-augmented solid screws. In terms of antitorsion ability, CPN-augmented solid screws were slightly better than CPN-augmented cannulated screws, but the difference was not significant.…”

Cement augmentation of pedicle screw fixation in spine surgery among patients with osteoporosis: a systematic review

“…Only one study mentioned its inclusion criteria regarding the severity of osteoporosis in vertebrae, as they included only grade I and grade II spondylolisthesis [21]. Two of the included studies mentioned that osteoporosis was diagnosed according to the osteoporosis diagnostic criteria of the World Health Organization's (T-score ≤ -2.5) as demonstrated in Table and in Figure 2 [21,22]. Regarding type and technique of cement augmentation, four included studies assessed fixation of the pedicle screw using bone cement [21][22][23][24].…”

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

“…Dai et al in 2015 evaluated the effect of cement injectable cannulated pedicle screws used in 43 patients with osteoporosis who underwent posterior spinal instrumentation and fusion. 25 The diagnoses included degenerative spondylolisthesis (49%), disc herniation or spinal stenosis (34.9%), ankylosing spondylitis (9.3%), and osteoporosis or compression fractures (16.3%). The fusion was assessed at 6 and 12 months after surgery with CT scans and showed and implied union rate of 100%, since no patients required revision surgery for nonunion or screw loosening.…”

“…23 The 3 studies on cement augmentation of pedicle screws are retrospective in nature, and all show a fusion rate of 100% on CT evaluation. 24,25,32 The 3 studies on expandable pedicle screws show a fusion rate of 86% to 100% based on radiographs and CT. 26-28 The study by Wu et al had the highest number of patients as well as prospective and randomized with an independent radiologist evaluation of fusion. The fusion rate of 92.5% found by Wu et al is the most accurate assessment of expandable pedicle screws.…”